Clinical applications of the monti procedure as a continent catheterizable stoma

Castellán, Miguel; Gosálbez, Rafael; Labbie, Andrew; Monti, Paulo R.

doi:10.1016/s0090-4295(99)00046-1

Cited by 56 publications

(33 citation statements)

References 15 publications

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“…In the series with longer follow-up periods, continence maintenance is always greater than 90% and shows no considerable changes with time (16,17 Four of these channels were double Monti channels, while the others were single Monti channels. Channel replacement was performed in three patients (7%) due to complete fibrosis, and 3 cases (7%) had stomal incontinence (16).…”

Section: Commentsmentioning

confidence: 89%

Monti’s procedure as an alternative technique in complex urethral distraction defect

et al. 2010

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Purpose: Pelvic fracture urethral distraction defect is usually managed by the end to end anastomotic urethroplasty. Surgical repair of those patients with post-traumatic complex posterior urethral defects, who have undergone failed previous surgical treatments, remains one of the most challenging problems in urology. Appendix urinary diversion could be used in such cases. However, the appendix tissue is not always usable. We report our experience on management of patients with long urethral defect with history of one or more failed urethroplasties by Monti channel urinary diversion. Materials and Methods: From 2001 to 2007, we evaluated data from 8 male patients aged 28 to 76 years (mean age 42.5) in whom the Monti technique was performed. All cases had history of posterior urethral defect with one or more failed procedures for urethral reconstruction including urethroplasty. A 2 to 2.5 cm segment of ileum, which had a suitable blood supply, was cut. After the re-anastomosis of the ileum, we closed the opened ileum transversely surrounding a 14-16 Fr urethral catheter using running Vicryl sutures. The newly built tube was used as an appendix during diversion. Results: All patients performed catheterization through the conduit without difficulty and stomal stenosis. Mild stomal incontinence occurred in one patient in the supine position who became continent after adjustment of the catheterization intervals. There was no dehiscence, necrosis or perforation of the tube. Conclusion: Based on our data, Monti's procedure seems to be a valuable technique in patients with very long complicated urethral defect who cannot be managed with routine urethroplastic techniques.

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Section: Commentsmentioning

confidence: 89%

Monti’s procedure as an alternative technique in complex urethral distraction defect

et al. 2010

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“…The conduit short arm must be equivalent to this length. It is important to keep in mind that the diameter of the intestinal loop and not its length is the factor that is going to determine the conduit final length [27]. To obtain a longer conduit, two ileal detubularized tubes in sequence may be anastomosed [26].…”

Section: Surgical Techniquementioning

confidence: 99%

“…In order to avoid complications secondary to malabsorption of vitamin B12 the final 15 cm of the ileum are spared [27]. A 2-2.5 cm long intestinal segment is isolated along with its vascular pedicle.…”

Section: Surgical Techniquementioning

confidence: 99%

Continent Urinary Diversions in Non Oncologic Situations: Alternatives and Complications

Miyaoka¹,

Aguiar²

2012

Urinary Incontinence

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“…The rationale for using the Monti principle to construct a continent gastrostomy was based on the encouraging results obtained by different authors in the performance of vesicostomies and cecostomies that showed to be continent and easy to perform (8)(9)(10)(11). The surgical technique does not present major difficulties and can be performed by anyone who is familiar with intestinal anastomoses.…”

Section: Commentsmentioning

confidence: 99%

“…The elaboration of catheterization tubes through transverse re-tubularization of small intestinal segments has provided its use in several segments of the digestive tract, allowing the performance of several functions through continent cecostomy and sigmoidostomy for antegrade intestinal enema used for treating neurogenic constipation (8)(9)(10)(11). Other uses can be tested in the future, such as continent jejunostomy for feeding gastrectomy patients where a gastrostomy is not possible.…”

Section: Commentsmentioning

confidence: 99%

Use of the monti principle for constructing a continent gastrostomy

et al. 2005

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Objective: To research technical alternatives for permanent gastrostomy that minimizes the drawbacks and complications reported by several authors.Materials and Methods: An experimental model was developed where the material was divided into 2 groups: the study group (SG) composed of 12 half-breed dogs where the proposed technique was applied, and the control group (CG) composed of 10 animals where a gastrostomy as proposed by Webster in 1974 was applied. On the 90th postoperative day, both groups underwent tests for assessing competence concerning leakage. These were performed under general anesthesia and following sacrifice.Results: In the SG, under anesthesia only one animal had leakage through the gastrostomy. Following sacrifice, leakage was observed in 2 animals. In the CG, under anesthesia, 2 animals had leakage and, following sacrifice, only 1 animal did not present leakage. On histopathological analysis of the SG, gastric mucosa was evidenced around the jejunal tubes, with normal features, moderate inflammatory mononuclear infiltrate in jejunal tubes and only slight infiltrate around the gastrostomy stoma. In the CG, ulceration was constant around the external stoma of the gastrostomy tubes. In the corium, the inflammatory infiltrate was less intense than in the SG. The SG proved to be more efficacious than the CG concerning leakage, and this efficacy is attributed to the submucous valvular system.Conclusions: The featured technique showed competence concerning leakage, allowing its clinical applicability as an alternative for permanent gastrostomy.

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Clinical applications of the monti procedure as a continent catheterizable stoma

Cited by 56 publications

References 15 publications

Monti’s procedure as an alternative technique in complex urethral distraction defect

Monti’s procedure as an alternative technique in complex urethral distraction defect

Continent Urinary Diversions in Non Oncologic Situations: Alternatives and Complications

Use of the monti principle for constructing a continent gastrostomy

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